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Neurologic symptoms found in 4 of 5 hospitalized COVID patients

Reg Gale
Bloomberg

About 4 out of 5 patients hospitalized with COVID-19 suffer neurologic symptoms such as muscle pain, headaches, confusion, dizziness and the loss of smell or taste, new research shows.

The most severe condition listed was encephalopathy, “characterized by altered mental function ranging from mild confusion to coma,” said Igor Koralnik, the chief of neuro-infectious disease at Northwestern Medicine in Chicago and one of the study’s authors. The study outlined the frequency and severity of neurologic symptoms in 509 patients hospitalized for COVID-19 in the Chicago-based health system at the start of the pandemic.

Koralnik, who also leads Northwestern’s neurology-focused COVID-19 clinic, declined to discuss the paper’s relevance to the condition of U.S. President Donald Trump, who has been diagnosed with the disease. He said doctors generally should be on the lookout for any signs of neurologic distress in COVID-19 patients.

“Even people who have mild respiratory problems that don’t last long are still at risk of long-haul symptoms” that can affect some COVID patients for months, he said by telephone.

Assessing Symptoms

The average age for those in the study with encephalopathy was 65, he said, compared with 55 years old for patients who didn’t have it. Patients with brain ailments were more likely to be male and have a shorter time from disease onset to hospitalization, according to the study. Patients with the condition also tended to have a history of other disorders, including high blood pressure.

The study was published today in the Annals of Clinical and Translational Neurology. It is one of the first published on the frequency of neurological symptoms tied to COVID-19 in a large population of patients, Koralnik said.

A study published in China found 36% of patients there had neurological symptoms, while one in Spain put the rate at 57%.

The difference in the Chicago study may be that hospitals there were never overwhelmed, like they might have been in other parts of the world. That may have made it easier for researchers to assess patients’ neurological symptoms.

Of the 509 patients studied, 42% had neurological problems when they first became aware they were infected, 63% at the time of hospitalization and 82% at any time during the course of the disease. The most frequent symptoms were muscle pain, headaches and encephalopathy.

Next Step

The next step, Koralnik said, is to determine what triggers these conditions. He said the group is continuing to study patients “who are discharged from the hospital, as well as in COVID-19 long-haulers, who have never been hospitalized but also suffer from a similar range of neurological problems, including brain fog.”

The phenomenon, involving thousands of patients with symptoms lasting months at a time, complicates the Trump administration’s argument that most illness is mild so the U.S. can quickly reopen the economy.

These frightening long-term cases aren’t captured in official statistics that show that the vast majority of younger adults survive the virus.

“What we’d like to know is if the virus somehow infects the brain itself or the wrapping of the brain in patients with encephalopathy,” Koralnik said. His group will be studying that in the future, along with possible immunological factors.